Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 00981 | Date 27/09/2018 |
| Token No | SM/21-22/274 18/05/2021 | Serial | 005 |
| Patient Name | Miss URMILA KHATIK | Contact No | 8820834468 |
| Address | DEY STREET | Age | 23 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||